Editorial: No need for a full-service veterans hospital

For the better part of a decade, every member of New Hampshire’s congressional delegatiyon has sponsored bills and promised to fight for the state to have a full-service veterans hospital of its own. Reps. Annie Kuster and Carol Shea-Porter did so again recently.

Though New Hampshire is the only state that lacks such a facility, there is a good reason why their efforts have come to naught. Returning the Veterans Administration Medical Center in Manchester to full-service status – it was downsized in 1999 for economic reasons – might not serve taxpayers or veterans well.

The VA hospital in Manchester offers primary care and services that most community hospitals don’t provide, things like treatment for post-traumatic stress disorder and traumatic brain injuries, which have increased tremendously due to the enemy use of roadside bombs.

But it makes more sense for veterans who need in-patient hospital care to receive it at area hospitals under contract with the Department of Veterans Affairs. That’s what happens to a limited extent now. While some vets seek inpatient care within the system at the veterans hospitals in Roxbury, Mass., or White River Junction, Vt., others are served by Concord Hospital, which invested in the capability to share medical records with the VA system to permit continuity of care.

New Hampshire is home to about 125,000 veterans. Some 22,000 of them receive their care in Manchester. The VA also operates four community-based outpatient clinics for veterans: in Tilton, Conway, Portsmouth and Somersworth.

A poll of the state’s veterans would likely find a divide. Some of them would want a full-service hospital exclusively for veterans, and some would prefer to have a special veteran’s card that allows them to be treated at their local hospital at government expense. Both systems have merit, but economy of scale is important. So is convenience.

The wars in Iraq and Afghanistan have created a whole new population of veterans who may require care for a half-century or more. They rejoined a society that is far more mobile than the one veterans of past wars returned to. A system that allows veterans to receive care at any hospital authorized by the VA to provide it would serve them better than traveling to one of the nation’s 152 VA hospitals.

Creating a full-service hospital is expensive, with costs for a new one measured in the hundreds of millions of dollars. Surgeons need to see a large number of patients and perform procedures repeatedly to develop and retain expertise. The patient base served by a full-service Manchester veterans hospital wouldn’t be large enough to allow them to do that. Doctors would have to be shared with other hospitals. A full-service VA hospital in Manchester would be a needless duplication of available services, something a society that spends more than twice as much as any other on health care can no longer afford.

Promising veterans a full-service hospital every election cycle needlessly raises hopes and does them a disservice. The state’s congressional delegation successfully convinced the veterans administration to permit the outsourcing of some care and the opening of regional clinics. It succeeded because those measures make sense. A full-service VA hospital does not.